The bulk of Gov. Deval Patrick’s emergency budget cuts hit providers of care to Medicaid recipients, with over half of the spending reductions being taken from rates paid to MassHealth providers.

Managed care organizations, nursing homes and fee-for-service providers saw the pot of money available for payments slashed by over $128 million on Tuesday. On Wednesday, state health officials interviewed by the News Service said the cuts should not impact patient access to care.

“Nobody is getting paid less than they did in 2012,” Health and Human Services Secretary JudyAnn Bigby said, noting the savings are achieved by reducing increases in the reimbursement rates baked into the fiscal 2013 budget.

While Patrick’s hand was forced by tax receipts that fell short of budget needs, some providers worry that a trend of turning to Medicaid rates to solve the state’s budget troubles could lead to patient access problems in the future if rates are not increased in the coming years.

“We continue to be concerned about not this specific cut, but the trend in the gap between what Medicaid pays and what it costs to care for patients. If we don’t begin to address that gap, yes, we think it will have an impact on patient care and staff and the ability of facilities to hire,” said Tara Gregorio, vice president of government relations for the Massachusetts Senior Care Association.

Patrick used his emergency budget-cutting powers to slash $225 million in executive branch spending, including $220 million in line item cuts. The reductions targeted special education funding, money for parks, and community residential services for the disabled, among many other accounts.

But more than half of the cuts came from MassHealth, including $86 million for managed care, $26.8 million for MassHealth fee-for-service payments, and $15.1 million for nursing home supplemental rates.

The cuts amount to about a 2 percent decrease in spending on those accounts, and reduced by one half the rate increases approved by the Legislative and signed off on by the governor in the fiscal 2013 state budget.

“Our first priority as we approached trying to support this effort to align expenditures with revenues was to think about how to prioritize, first, members and you saw no member benefit cuts in any of the initiatives we proposed and on the provide side no provider actually experienced a cut. The changes we made were adjusting what would have been increases over FY 12 so we have no concerns that it’s going to create access concerns for our members,” said Dr. Julian Harris, director of the state Office of Medicaid.

Bigby said preserving access to care, particularly as the state implements an overhaul of the health care payment system with an emphasis on coordination and primary care intervention, factored into the administration’s decision making.

“I think that when we looked at where we could cut we were very mindful of (those issues) and we’re working with those entities to make sure it doesn’t jeopardize access,” Bigby said.

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Asked about concerns that rate cuts would discourage providers from caring for Medicaid patients, Bigby said, “Medicaid covers almost one-and-a-half million people. I think it would be very hard for people to say they don’t want to participate.”

Gregorio said senior care and nursing facilities operate with a $32-per-day gap between MassHealth reimbursements and the cost of providing care to patients. If left untouched, the rate increases would have shaved $2-per-day off the gap.

“Obviously our members are concerned about the cut and we want to continue to work with the governor and the Legislature to close the gap between what Medicaid pays and what it costs to care for the patient,” Gregorio said.

Gregorio said the Patrick administration kept the Senior Care Association apprised of its plans and has already invited the group to participate in planning for the fiscal 2014 budget. “In some ways fiscal 2013 has been written for us and we’re looking toward 2014,” she said.

Dr. Richard Aghababian, president of the Massachusetts Medical Society, said the historic underfunding of Medicaid reimbursement rates and the threat of further cuts to the program at the federal level through “fiscal cliff” negotiations are reason to be worried.

“Physicians are deeply concerned with any spending cuts to health care programs that affect patient access to care and the viability of physician practices, especially those that are not funded to appropriate levels for provider rates, such as Medicaid,” Aghababian said in a statement to the News Service. “Our concern becomes even greater when those cuts are coupled with impending Federal reductions in Medicare rates for physicians and further cuts to health programs and research that may result from the 2011 Budget Control Act.”

The Massachusetts Hospital Association said the latest round of Medicaid cuts “comes on top of a long list of reimbursement reductions that place many hospitals and the programs they provide in greater jeopardy.”

In a statement, the provider organization said expanded access to Medicaid – which has grown by 300,000 individuals since 2006 – is not enough.

“The expansion is an accomplishment we should all be proud of, but the state’s responsibility does not end with enrolling people in Medicaid; its responsibilities extend to adequate funding for their care,” the MHA statement said.

In light of sluggish economic growth and continued pressure on the state budget, Senate Minority Leader Bruce Tarr’s reaction to the cuts included a call for Medicaid patients to be moved into so-called managed care plans.

“It’s time for the Legislature to revisit and take action on initiatives to control the cost of health care, including moving Medicaid patients to managed care and addressing costly health care mandates,” Tarr said.

Republican lawmakers over the years have been unable to convince Democrats who control the Legislature to support moving MassHealth patients into managed care plans. Medicaid recipients in Massachusetts can choose between one of five managed care organizations, or a primary care clinician plan.

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Many states have moved away from managed care over the years, but rising costs and the increasing percentages of state budgets consumed by Medicaid spending have kept it on the radar screens in many state Legislatures.

“With a new Legislature, the managed care drum may start beating again,” said Michelle Probert, director of strategic initiatives for MaineCare, who presented Wednesday at a conference organized by the Massachusetts Medicaid Policy Institute featuring health care officials from Maine, Colorado, New York and Oregon.

Harris said Massachusetts has strong relationships with its managed care organizations and primary clinician plans, and is focused on reforming the model of care delivery for all patients with a focus on primary patient-centered medical homes and accountable care organizations.

“In some sense I think this conversation, MCO versus PCC, is outdated in Massachusetts,” Harris said, noting that in some states managed care proved to be more expensive and “catastrophic” to the quality of care.

“As we think about our approach to primary care payment reform, we’ve been working closely with the MCOs so that it’s a model that actually spans both programs and leverages the strengths and the expertise embedded in both programs,” Harris said.